The divergent role of the GM-CSF/GM-CSFR signaling pathway in cholangiocarcinoma and pancreatic ductal adenocarcinoma.
Authors: Yatee A. Dave, Paul R. Burchard, Luis I. Ruffolo, Nicholas A. Ullman, Mary Georger, Rachel Jewell, Brian A. Belt, David Linehan
Journal: Journal of Clinical Oncology (2023)

736 Background: The granulocyte-macrophage colony-stimulating factor ligand and receptor (GM-CSF/GM-CSFR) pathway plays a multifaceted role in the setting of cancer, exerting an anti-tumorigenic or pro-tumorigenic effect depending on GM-CSF expression. In previous work, we and others have shown increased GM-CSF expression to correlate with poor prognosis in patients with cholangiocarcinoma (CCA) and pancreatic ductal adenocarcinoma (PDAC). We also demonstrated how GM-CSF neutralization leads to reduced tumor size in murine CCA models, in part due to inhibition of alternative macrophage polarization. Here, we explore the impact of blocking GM-CSFR signaling in CCA and PDAC, two immunologically cold tumors with poor prognoses. Methods: Immunohistochemistry (IHC) and digital quantification of staining was performed on tissue from a human PDAC and CCA databank. Murine F4/80+ bone marrow-derived macrophages were cultured in tumor-conditioned media (TCM) derived from PDAC (KP2) or CCA (URCCA4.3) cell lines, with and without anti-GM-CSFR antibody. Quantitative real time PCR (qRT-PCR) analysis was performed for gene expression. URCCA4.3 and a luciferase-labeled PDAC (KCKO) cell line were orthotopically implanted into Bc/BIL3 knockout (KO) mice which lack GM-CSFR and C57BL/6 mice. Mice implanted with URCCA4.3 were enrolled into vehicle or gemcitabine treatment groups. Mice implanted with KCKO were untreated. Tumor growth was monitored by ultrasonography or bioluminescence imaging. Results: Digital analysis of IHC staining for GM-CSFR in human PDAC tumors revealed low expression to be associated with improved overall survival (OS) and greater number of days to recurrence, while high levels were associated with worse OS and fewer days to recurrence (p&lt;0.01). In addition, human CCA specimens had greater GM-CSFR expression compared to normal uninvolved liver (p&lt;0.01). qRT-PCR analysis of RNA from bone marrow-derived macrophages exposed to either CCA or PDAC TCM demonstrated lower expression of genes associated with alternative macrophage polarization ( Arg1, Cd274, Pdcd1lg2) and chronic inflammation ( Ccl2, Ccl17, Irf4) (all p&lt;0.01) in response to GM-CSFR blockade. GM-CSFR KO mice implanted with URCCA4.3 demonstrated no differences in tumor growth with or without chemotherapy, compared to wild-type controls. Similarly, KO mice implanted with an immunogenic PDAC cell line (KCKO) had no differences in tumor size compared to wild-type controls. Conclusions: GM-CSFR expression is prognostic in the setting of PDAC and elevated in human CCA compared to normal liver. In vitro, GM-CSFR blockade downregulated pro-tumor genes associated with immunosuppression and inflammation. However, complete disruption of GM-CSFR signaling reversed the efficacy generated with GM-CSF ligand neutralization, suggesting some signaling is required for inducing anti-tumor immune responses.